Risks and precautions for peanut-allergic kids in schools

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The treatment of a Florida girl with peanut allergies at her school and the reaction of community members to precautions to keep her safe in school made headlines recently.

Precautions have included requiring students to wash hands and faces before entering classrooms and searching the school with a peanut-sniffing dog. These efforts have not been well-received by other parents.

The situation has resulted in a group of parents requesting that the child be home-schooled rather than have the school make further accommodations as are legally required by section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act.

As a researcher and pediatric allergist with experience investigating reactions in educational settings, it seems that stakeholders in this case need further information about the real risks that exist for a child with a food allergy attending school. This confusion may have resulted in policies that have created stress to all involved.

Here is what studies have shown:

Reactions occur at schools and can be severe in certain circumstances. These tend to occur more frequently in younger children. The vast majority of food allergic children attend school safely every day.

The risk of environmental accidental contact is low. One study found researchers failed to detect peanut in air filters at the level of the neck after volunteers danced on peanuts on the floor of a poorly ventilated room. Another study showed no detectable peanut levels found on common school surfaces after they were cleaned with commercial products, and that hand washing (but not liquid hand sanitizer) was sufficient to remove peanut from one’s skin. No known case of a reaction attributable to oral contact from kissing or spit has been documented at a school.

Peanut-free and tree nut-free policies believed to protect students at schools may not be effective. One study showed that despite such measures, upwards of 19% reported a reaction still occurred.

When reactions occur, treatment is delayed or the wrong treatment is used. There is evidence that emergency action plans are not always followed as written, and that many food-allergic students neither maintain an emergency action plan nor maintain emergency medication such as epinephrine at school.

In older children, intentional risk-taking and indifference to their food allergy has been documented.

Strategies, such as hand washing after food contact, not sharing food, and being aware that certain children have dietary restrictions when planning craft projects or celebrations can be of great use and pose minimal disruption to the food-allergic child and the unaffected children.

While there is a recognized risk for a food allergy to occur at school, it’s unlikely to happen without the child ingesting a peanut-containing product. It’s also likely that the school and the food-allergic family are not always prepared to treat reactions. Kids with food allergy can safely attend school and this is the common goal that we must work to achieve.

Matthew Greenhawt, MD, MBA, FAAP
Assistant Professor
The University of Michigan Medical School